[Diffuse interstitial lung disease of possible occupational origin treated at the Navarra Health Service. Navarra, Spain, 2017-2022]. / Enfermedad pulmonar intersticial difusa de posible origen laboral atendida en el Servicio Navarro de Salud. Navarra, España, 2017-2022.

INTRODUCTION: Diffuse interstitial lung disease (ILD) describes a broad group of pulmonary inflammatory and fibrosis disorders. Asbestosis and silicosis are the main causes linked to occupational exposure. The aim of this study was to estimate the proportion of cases with possible occupational origin and describe their exposure, clinical, and occupational status. METHOD: We conducted a retrospective longitudinal study of ILD cases between 2017 - 2022 at the University Hospital of Navarra was conducted. Information was supplemented with interviews of cases with possible occupational origin. The occupational proportion was calculated, labor and clinical characteristics analyzed, by statistical comparison of percentages and means. RESULTS: Out of 1067 ILD cases, 56 had a possible occupational origin 5,2% (95% CI 3,9-6,6%). 36 (64,3%) corresponded to asbestosis, 15 (26,8%) to silicosis, and 5 (8,9%) to unspecified pneumoconiosis. The most frequent activities in silicosis were "stone cutting-carving" and in asbestosis "manufacture of iron products". The average age of asbestosis cases was higher than that of silicosis cases (78,2 vs. 67,3 years), as well as their clinical manifestation. Five cases (8,9%) had been recognized as occupational diseases. CONCLUSIONS: The implementation of a computer tool in medical records has made it possible to estimate the magnitude and assess the evolution of occupational ILD treated in the Public Health Service. Economic activities reflect the economic risk structure of the region. However, there is a lack of recognition of these diseases as occupational illnesses and they represent a preventable burden of respiratory disease.

Introducción: La enfermedad pulmonar intersticial difusa (EPID) describe un amplio grupo de trastornos con inflamación y fibrosis pulmonar. La asbestosis y la silicosis son las principales causas por exposición laboral. El objetivo de este trabajo fue estimar la proporción de casos de posible origen laboral y describir la exposición, situación clínica y laboral.  Método: Estudio longitudinal retrospectivo de los casos de EPID, en el período 2017-2022 en el Hospital Universitario de Navarra. Se completó la información con entrevista a los casos de posible origen laboral.  Resultados: De un total de 1067 casos de EPID, 56 tuvieron un posible origen laboral, 5,2% (3,9-6,6 IC 95%) 36 (64,3%) correspondieron a asbestosis, 15 (26,8%) a silicosis y 5 (8,9%) a neumoconiosis no especificada. Las actividades más frecuentes en silicosis fueron "corte-tallado de piedra" y para asbestosis "fabricación productos hierro". La media de edad de los casos de asbestosis fue superior a los de silicosis (78,2 vs. 67,3 años), así como su afectación clínica. Cinco casos (8,9%) habían sido reconocidos como enfermedad profesional  Conclusiones: La implementación de una herramienta informática en historia clínica ha hecho posible estimar la magnitud y valorar la evolución de las EPID laborales atendidas en el servicio nacional de salud. Las actividades económicas reflejan la estructura económica de riesgo de la región. Sin embargo, existe una falta de su reconocimiento como enfermedad profesional y suponen una carga de enfermedad respiratoria evitable.

Sodium tanshinone IIA sulfonate attenuates silica-induced pulmonary fibrosis in rats via activation of the Nrf2 and thioredoxin system.

Silicosis is characterized by pulmonary fibrosis due to long-term inhalation of silica particles. Although the cause of this serious disease is known, its pathogenesis remains unclear and there are currently no specific treatments. Recent studies have shown that the anti-oxidant transcription factor Nrf2 is expressed at reduced levels in fibrotic foci, which may be related to disease progression. However, the molecular mechanisms by which this might occur have yet to be elucidated. Sodium tanshinone IIA sulfonate (STS), an extract of Salvia miltiorrhiza, is used in traditional Chinese medicine in the treatment of coronary heart disease. STS has been shown to play a strong anti-oxidative role in various organs. Here, we employed a rat model to explore the effects of STS on oxidative stress and the progression of fibrosis in silicosis. STS significantly reduced collagen deposition in the lungs, thereby antagonising silicosis. Immunohistochemical and immunofluorescence staining showed that Nrf2 was differentially expressed in lung cells during silica induced fibrosis, and chromatin immunoprecipitation-sequencing experiments demonstrated that Nrf2 promoted the expression of the antioxidant proteins thioredoxin and thioredoxin reductase. Our results suggest that the anti-fibrotic effects of STS may be related to upregulation of Nrf2 nuclear expression, especially in fibrotic lesions, and the promotion of thioredoxin and thioredoxin reductase expression. Our findings may open up new avenues for the development of STS as a treatment for silicosis.

Effect of Xinjiang Uyghur Vernonia anthelmintica Willd Injection Treatment with Silicosis Fibrosis.

Objective. To observe the curative effect of VAWI on Xinjiang Uygur patients with silicosis fibrosis. Methods. After we diagnosed the 40 patients with the first phase of silicosis, we randomly divided them into two groups: the basic treatment group (group A, n = 20) and the VAWI group (group B, n = 20). At the same time, we selected the age-matched healthy patients (n = 20). We applied the combined protein chip with SELDI-TOF-MS to carry out the serum analysis. The data were analyzed throughout data preprocessing, difference in PEAK screening, hierarchical cluster analysis, and Principal Component Analysis (PCA). We built decision tree model and predict the difference between the PEAK corresponding proteins. Results. The proteins peaks corresponding to name, predicted protein, and gene name were as follows: M2001_69, amyloid beta a4 protein, APP, and M2017_02, amyloid beta a4 protein, APP. The different expression of proteins in patients with silicosis was found before and after with VAWI treatment. The predicted proteins were as follows: M1982_50, amyloid beta a4 protein, APP; M3164_50, fibrinogen alpha chain frag, FGA; M3379_28, fibrinogen alpha chain frag, FGA; and so on. Conclusion. VAWI presented curative effect on patients with silicosis fibrosis via the alternation of proteins expression in serum.

Endobronchial valves in the treatment of persistent air leak, an alternative to surgery.

INTRODUCTION: Persistent air leak is frustrating for both patients and physicians, above all leaks with a high risk of surgery. Insertion of endobronchial valves could be an alternative to surgery. The aim of this study is to describe our experience in these valves and analyse their efficacy in a series of patients with persistent air leaks. MATERIAL AND METHODS: The valves are inserted by means of flexible bronchoscopy under conscious sedation and local anesthesia. A preliminary bronchoscopy identifies the air leak by bronchial occlusion using a balloon catheter. A successful outcome is defined as complete disappearance of the leak following removal of the chest drain, without the need for further surgery. RESULTS: From November 2010 to December 2013, 8 patients with persistent air leaks were treated with endobronchial valves. The number of valves used ranged from 1 to 4 (median 2), with a median duration of air leak prior to placement of 15.5 days. There were no complications and the resolution of the leak was complete in 6 of 8 patients (75%). The median duration of drainage after insertion of the valves was 13 days and the median time to removal of 52.5 days. CONCLUSIONS: Insertion of endobronchial valves is a safe and effective method for treating persistent air leaks, and a valid alternative to surgery.

Association between lymph node silicosis and lung silicosis in 4,384 German uranium miners with lung cancer.

This study investigates the association between lymph node-only and lung silicosis in uranium miners with lung cancer and exposure to quartz dust. Tissue slides of 4,384 German uranium miners with lung cancer were retrieved from an autopsy archive and reviewed by 3 pathologists regarding silicosis in the lungs and lymph nodes. Cumulative exposure to quartz dust was assessed with a quantitative job-exposure matrix. The occurrence of silicosis by site was investigated with regression models for exposure to quartz dust. Miners with lung silicosis had highest cumulative quartz exposure, followed by lymph node-only silicosis and no silicosis. At a cumulative quartz exposure of 40 mg/m(3) × years, the probability of lung silicosis was above 90% and the likelihood of lymph node-only silicosis and no silicosis do not differ anymore. The results support that lymph node silicosis can precede lung silicosis, at least in a proportion of subjects developing silicosis, and that lung silicosis strongly depends on the cumulative quartz dose.

Sputum screening for lung cancer in radon exposed uranium miners: a comparison of semi-automated sputum cytometry and conventional cytology.

Preparing for a prospective study on early lung cancer, correlation between semi-automated sputum cytometry (ASC) and conventional cytology (CY) was examined in 1517 former uranium miners with posterior-anterior and lateral chest roentgenograms. A hundred and twenty sputum specimens were classified as suspicious (grade II) and another 18 as highly suspicious (grade III) by ASC. Within grade III group, 9 samples were classified by CY as tumor cell positive, 7 severe, and 1 mild and 1 moderate dysplasias. In the group of grade II ASC, 7 were tumor cell positive, 27 classified as severe dysplasia or CIS, 20 as moderate and 19 as mild dysplasia. Twenty seven contained metaplasias and 18 were normal or inflammatory. Of the 1358 samples classified as benign (grade I) by ASC, only 5 samples were classified by CY as severe dysplasia, 6 as moderate and 34 as mild dysplasia, 173 as metaplasia, the others were normal or inflammatory. Twenty one samples were judged as inadequate for ASC and CY. At present, 23 tumors were found in final diagnosis. Sensitivity of ASC was 87% at a specificity of 92%, while CY, at high grade alterations as a threshold, had a sensitivity of 83% at 97% specificity. We conclude that, along with modern radiological procedures and molecular biological markers, ASC and CY should be included in a controlled prospective randomized study on early lung cancer.

Role of exposure to radon and silicosis on the cell type of lung carcinoma in German uranium miners.

BACKGROUND: In East Germany, uranium mining was undertaken on a large scale from 1946 to 1990. Poor working conditions led to a high level of exposure to ionizing radiation and quartz dust. This analysis evaluates the histopathology of lung carcinoma in uranium miners in relation to radon exposure and silicosis. METHODS: A database developed for autopsy cases ascertained in a pathological tissue repository of German uranium miners was used to estimate odds ratios for developing lung carcinoma by major cell type with regard to radon exposure and silicosis. Silicosis information was extracted from autopsy protocols. Working level months (WLM) were calculated with a job-exposure matrix to assess lifetime radon exposure. Risk estimates were based on 3414 male miners who died from small cell lung carcinoma (SCLC, n = 1446), squamous cell carcinoma (SqCC, n = 1006), or adenocarcinoma (AC, n = 962) between 1957 and 1990. RESULTS: SCLC and SqCC seem more likely to be associated with high radon exposure than AC. Mean cumulative radon exposure was 868 (SD 631) WLM in SCLC, 871 (SD 652) WLM in SqCC, and 743 (SD 598) WLM in AC. Silicosis prevalence was 26% in SCLC, 38% in SqCC, and 30% in AC. In silicotics, AC and SqCC had a relatively higher frequency at the expense of SCLC. SCLC occurred earlier than AC and SqCC. CONCLUSION: High radon exposure was associated with a higher relative frequency of SCLC and SqCC than AC. Silicosis tended to increase the appearance of SqCC and AC.

Tracheobronchial obstruction due to silicosis.

Broncholithiasis can result in airway obstruction through the erosion of calcified lymph nodes into the bronchial lumen or by extrinsic compression of the tracheobronchial tree. We report an unusual case of broncholithiasis in a patient with silicosis who developed airway obstruction from endobronchial polypoid masses of granulation tissue adjacent to calcified mediastinal lymph nodes. The production of granulation tissue may have been the result of broncholiths in the early stages of erosion into the tracheobronchial tree. Efforts to ablate the endobronchial polyps using YAG laser phototherapy were only temporarily successful and surgical removal of the calcified mediastinal lymph nodes was required to halt further polyp growth. Surgical specimens grew Mycobacterium avium-intracellulare (MAI), a common pathogen in patients with silicosis. MAI may have contributed to the local inflammatory milieu provoking the exuberant tissue response.

Silica-induced scleroderma.

In a survey done in East Germany between 1981 and 1988, we found that 93 of 120 male scleroderma patients had long-term exposure to silica dust. We describe our findings in 12 patients with scleroderma and silicosis. The exposure time to silica dust was between 3 and 34 years; the interval between the beginning of exposure and the onset of scleroderma averaged 27.3 years (range 9 to 40 years). Antinuclear antibodies in titers between 80 and 10,240 with nucleolar and/or speckled patterns were found in 10 patients, antibodies against double-stranded DNA in three, Scl-70 (topoisomerase I) in three, and anticentromere antibodies in five. The following markers of collagen metabolism were increased in serum: beta-galactosidase in 12 patients, laminin peptide-P1 in 10 patients, N-terminal procollagen type III peptide in 10, and urinary sialic acid excretion in 7. We propose that crystalline particles of silica less than 5 microns may be phagocytosed by macrophages and release lymphokines and monokines, which activate fibroblasts and enhance their collagen and glycosaminoglycan synthesis. In addition, silica may act as an adjuvant to increase immune reactivity.

[Mechanisms of the development of immunodependent inflammation in silicosis]. / Mekhanizmy razvitiia immunozavisimogo vospaleniia pri silikoze.

Patients with uncomplicated silicosis were found to develop chronic immunodependent inflammation caused by an adjuvant effect of silica and characterized by autoimmune, histamine- and complement-dependent components. Reduced specific and non-specific antimicrobial defence underlies frequent complication of silicosis by tuberculosis and nonspecific infectious diseases of the bronchopulmonary system. A diagram showing the development of immunodependent inflammation in silicosis is presented.